Kelly Pristach, M.S.ED CCC/SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

025818-1 Issued in NY

Practice address

149 N Main St
Fairport, NY 14450-1434

Phone

(585) 377-2230

Fax

(585) 377-2312

NPI assigned

Dec 31, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bright Start Pediatric Services

  • Early Intervention Provider Agency
  • Fairport, NY
  • NPI 1467618231
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1419984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598227200000",
    "number": "1235527037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1249 HOLLEY RD",
            "city": "WEBSTER",
            "state": "NY",
            "postal_code": "145809581",
            "telephone_number": "585-705-1196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 N MAIN ST",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144501434",
            "telephone_number": "585-377-2230",
            "fax_number": "585-377-2312"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "51 High St",
            "address_purpose": "LOCATION",
            "city": "Lockport",
            "state": "NY",
            "postal_code": "140944333",
            "country_code": "US",
            "telephone_number": "716-478-4751",
            "fax_number": "716-201-4637",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRISTACH",
        "first_name": "KELLY",
        "name_prefix": "Mrs.",
        "credential": "M.S.ED CCC/SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-31",
        "last_updated": "2020-08-24",
        "certification_date": "2020-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "025818-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Jane Price, LMHC
• Tamara May Price, LPN
• Heather Principino
• Nicole Lynn Principino, SLP
• Heather Gean Prinsen
• Laurie S Pritchard, OT
• Danielle Harmon Privitera, MD
• Proactive Chiropractic and Wellness PLLC
• Christine E Proctor, RN
• Nicholas C Prosser, D.C

• Speech-Language Pathologist in Fairport, NY
• Providers in Fairport, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.